Treatment and Care Options for Epilepsy
There are several options for treating epilepsy, and the best choice for treatment will vary with each case. Epileptologists typically treat with medical, surgical, implant devices, or nutritional interventions.
Medicine to Treat Epilepsy
Epilepsy is treated with anti-epileptic drugs, or AEDs. There are several different types and brands of AEDs, with some common examples being carbamazepine, levetiracetam and lamotrigine. These medications may cause side effects such as fatigue, changes in weight, changes in behavior, renal stones, and rash. Talking to a physician about which medicine is right for you is always best practice when it comes to medications.
Surgical options are explored at any age, including young children, when medications are not sufficiently managing the epilepsy. Patients require a complex evaluation from their physician before deciding on surgery. This may include several brain imaging techniques and long-term electroencephalogram (EEG) monitoring in the hospital. The goal for this comprehensive evaluation is to identify the part of the brain that is causing the seizures and assess if it can be safely removed with brain surgery.
Those who are not good candidates for surgery may qualify for implant devices like the vagus nerve stimulator implant. The vagus nerve stimulator is inserted below the left collarbone, and small wires attached to the stimulator send pulses of electricity to the nerve. The device is set to stimulate the nerve at regular intervals, adjusted at follow-up visits to suit the patient’s needs. Most patients see a reduction in frequency and severity of seizures but not an overall end.
Another device that is currently approved for adults, and for which there is growing data on safety and efficacy for children as well, is a responsive nerve stimulator. This option should be considered when seizures are coming from an area of the brain that could not be safely removed with surgery, for example because that would lead to permanent weakness or paralysis of a limb. After implanting electrodes on the brain surface or inside the brain, this device can monitor brain waves, then respond with a stimulation to activity that is different from usual or that looks like a seizure.
Diet therapy can be a good option for children whose medications don’t control seizures or cause too severe side effects. The best diet option for a child depends on the diagnosis, eating habits, age, family preferences, and if the child has a gastrostomy tube (G-tube).
This option is restrictive and requires a high degree of precision and commitment, which is sometimes impractical, especially for young children without a G-tube. However, it has been shown to be effective for many children with epilepsy when medication fails. This diet provides more than 90 percent of its calories through fat, which the body then burns for energy rather than burn glucose from carbohydrates. This produces ketone bodies, an increase of which is called ketosis. Experts believe that ketosis reduces seizure activity in the brain. Children need to take vitamin and mineral supplements while on this diet to supplement other nutritional areas. Side effects can include constipation, bruising, and kidney stones.
Modified Atkins Diet
This less restrictive option is easier for the child to follow and can lead to similar results as the ketogenic diet.